急性坏死性胰腺炎211例治疗经验

Experiences in management of acute necrotic pancreatitis

为确立急性坏死性胰腺炎（ＡＮＰ）的治疗方案，作者对比研究了以早期手术为主的Ａ组（１９９２年以前的１２２例）和以早期非手术治疗为主的Ｂ组（１９９２年以后７５例，１９９２年以前１４例，共计８９例）患者的并发症发生率和死亡率。结果Ｂ组并发症（ＡＲＤＳ、肾衰、心衰）的发生率和死亡率明显低于Ａ组（Ｐ＜０．０１）。对ＡＮＰ的治疗采取早期非手术治疗明显优于早期手术治疗。作者讨论了非手术治疗的方法、非手术治疗期中转手术的指征、及ＡＮＰ的治疗方案。

To establish a treatment program for patients with acute necrotic pancreatits (ANP), we treated 211 patients with ANP from 1973 to 1995.122 patients in group A were treated mainly by early operation before 1992 and 75 in group B,by early nonoperativemethod. The results showed that the occurrance of complications (ARDS,renal failure,heart failure, pancreatic abscess, intestinal fistula) was lower than that in the group B ( P <0 01). Also the mortality in the group B (10 67%) was decreased as compared with that (22 95%) in the group A. We suggested that the nonoperative treatment with rigid criterion for ANP might be recommended first. An intensive nonsurgical management of ANP, surgical indications during nonoperative period and complete program of management for ANP were discussed.